Preconception to post-natal health: case studies and clinical pearls, with Catherine Jeans

Preconception to Post-Natal Health: Case Studies & Clinical PearlsCATHERINE JEANS DIPION MBANT CNHCTHE FAMILY NUTRITION EXPERT

www.thefamilynutritionexpert.com Catherine Jeans 2016

Catherine Jeans Nutritional Therapist

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The Family Nutrition Expert, Catherine Jeans 01603 631900 www.thefamilynutritionexpert.com

Telegraph & Aldi Nutritional Therapist


Overview

The practicalities of working with fertility & things I’ve learned Case Study: Fertility Couple

Why are the adrenals so important for fertility – and how to support them when someone is trying to conceive

Case Study: Adrenal fatigue, thyroid health and getting pregnant Other key functional tests for fertility – from thyroid to HMA

Case Study: How copper may inhibit fertility I’m pregnant… now what? How to support a client through pregnancy –

typical concerns, problems, how to create a pregnancy package Post-natal recovery and beyond – why are so many Mums (especially 2nd

and 3rd time Mums) presenting with symptoms of adrenal fatigue? Case Study: Over-coming adrenal fatigue when sleep deprived

Questions?


Fertility and Pre-conception

The types of client you might see: Couples or individuals thinking about conception – want to get in best possible

health Those who’ve been trying to conceive for a while – don’t want to have IVF/or

IVF not an option Those about to privately fund IVF 1 or 2 failed IVF – last NHS funded cycle coming up Recent miscarriage or recurrent miscarriage Secondary fertility problems Women over 40 – last attempt to have a family


Your job is to….

The Clinic

not the "Ah-ha" moment ... about getting all the pieces in the pie


Important Considerations:

Make sure your recommendations do not cause added stress You’re going to empower the person or couple to take back

some control – feel like they’re doing something for themselves Some need reassurance that they’re doing the right thing Some don’t want in-depth consultations – just simple changes

that are easy to follow Where does your support end? At conception?


Things I’ve learned about working with fertility:

It’s not for everyone… it’s a HUGE responsibility, and it’s not for everyone

Can be very exciting – doing the detective work is fascinating Work with other therapists…. It’s good to put your heads together Keep learning… CPD is key You’ll never work with a more motivated group of clients Do as much testing as you can… get the info you need to put in the

most bespoke protocol Listen to your client… often they know more than you!


Case Study: Couple in early 30sSimon and Natasha


Case Study: Natasha and Simon

2 Failed IVF attempts in last year – 1 fresh cycle, 1 frozen; 1 NHS-funded cycle left – in next few months; Both cycles lots of eggs retrieved, several fertilised; got to early blastocysts Natasha has PCOS? – no period in 4 years. On metformine. Started pill age 20. Before then periods regular. On pill 9 years. “Polycystic ovaries” but not syndrome – not overweight, no excess hair, just

polycystic ovaries Thyroid not checked No feedback on why last round not successful


Further questioning found out…

Natasha often constipated – BM every 3 days, rabbit pellets Struggles to relax – did try a bit of meditation, gave up Used to have very stressful teaching job A lot of stress when last cycle failed… Discussing with Natasha and Simon – he suspects she does too much

exercise, not relaxing enough… Want to make sure doing all they can before last NHS-funded round Diet already really good – rich in lean protein, oily fish, fresh fruit and

veg, wholegrains, low in alcohol, occasional dessert


Is there anything I can do here?

Asked her to get IVF clinic to review blood test results – send me copies as well. Thyroid check (TSH, T4, T3, Thyroid antibodies), iron, B12, folate, Vitamin D. Rule everything out.

Could they slow down IVF cycles? Age on their side, why the rush? Give themselves time to properly rebalance and prepare

Big discussion around relaxation and sleep – what would work for Natasha? How to support adrenals… weekly lay in, yoga, meditation Diet – blood sugar balancing…

insulin peaks may reduce SHBG – releasing more free testosterone? Focus on adrenal health – to support progesterone levels (maintain pregnancy)

They might consider Self-hypnosis, Hypnofertility, massage, acupuncture Re-emphasised what they are doing right…


Focus on…

Lean protein with every meal and snack: blood sugar balance Plenty of foods rich in omega 3 At least 7 F & Veg per day, not too much fruit. Lots of variety Wholegrains, no refined carbs or sugar But having a treat every now and then… “Get drunk and have some great sex!” Replenish body after exercise – include some wholegrain carbs Better quality supplements


Outcome of Case Study 1

Natasha and Simon were so grateful for the appointment… Just one appointment was enough for them.

“Thank you so much… we feel an enormous

sense of relief…”

“It’s just so good to talk to someone who can give really practical advice, and sort out the key things we can do for ourselves when it comes to fertility…”


Fertility… why start with the adrenals?I NEVER DO A FEMALE HORMONE PROFILE, WITHOUT ALSO TESTING ADRENAL GLANDS. WHY?


Let’s look at pregnenolone steal


Potential consequences of pregnenolone steal

Body uses up pregnenolone to create cortisol needed for stress…

This happens in extreme stress/advanced maladaption of adrenal glands


Potential consequences of pregnenolone steal

So this means… Reduced progesterone – which may increase risk of miscarriage, as

not enough progesterone present to maintain pregnancy Oestrogen dominance – progesterone is an important balancer of

oestrogen This could potentially disrupt ovulation, increased risk of PCOS,

endometriosis, amenorrhea, adrenal fatigue, thyroid issues Also remember nutrient loss from adrenal stress… Could become

deficient in magnesium, vitamin C, zinc, B vits etc…


HPA or ATO axis…

We have a delicate endocrine balance along Hypothalamus-Pituitary-Axis and Adrenal-thyroid-ovarian axis

As adrenal stress and adrenal fatigue advance – increased risk of secondary hypothyroidism

Body increases reverse T3 – like a braking system – metabolically down regulate to conserve energy

High reverse T3 can persist after stress gone Is thyroid routinely checked in fertility investigations? Certainly not T3.


Case Study: Claire, age 28

Claire, age 28. TTC 3 years. Diet was okay – but very low in protein, sometimes skipped meals (had

been put on alkalising diet by another therapist) BMI 19 Periods generally regular – not heavy or light; regular cycle, about 29 days; “The amount of stress we have had is unreal” eg Dad prostate cancer Teaching assistant – work stressful for 9 years Not good with change, sometimes gets anxious Cold hands and feet, BM every other day, dry skin


Case Study: Claire, 28

Partner low in iron (low Hb) Wanted to support fertility naturally Not ovulated for 4 months Bit fuzzy headed Bloating after most meals Came with a lot of blood tests: RBC, Hb, all normal; STD clear; hormone

tests normal; Thyroid: TSH 1.75, T4 at 14 Budget was an issue;


Adrenal Stress Index: GDX


Female Hormone Profile: Red Apple

At first glance, a surprisingly good cycle. Oestrogen peak – good. But slightly too

high – overshot… then drops very low Progesterone – drop off too quickly…

could be higher at her age. Nearer to 500. No progesterone to spare.

Is DHEA trying to buffer up cortisol?


Barnes Basal Temperature Test

Thyroid hormone is so vital to cellular metabolism – which is why low thyroid function can often manifest as a reduced body temperature.

Broda Barnes Barnes recommended the following procedure: Immediately upon awakening, and with as little movement as possible, place

thermometer under the tongue or arm. Does work with digitial thermometer. Do for 3 consecutive days, ideally from days 2 to 5 of period.

If the average temperature over the three days is less than 97.8oF / 36.6oC this could indicate hypothyroidism (where the temperature is consistently above 98.6oF / 37oC this is an indication you may have hyperthyroidism)

If testing under the arm, some experts advise adding 0.5C to each reading, as it’s generally lower in temperature under your arm compared to mouth or rectum


Barnes Basal Temperature Test: Claire

From 2nd day of period: 35.97/35.99/35.98/36/36.06 Anything less than 36.6 may indicate subclinical hypothyroidism? I was concerned about her thyroid, despite NHS tests coming back normal I knew that she couldn’t afford further testing…. What about her other symptoms? Constipation, low energy, dry skin (despite

being on EFA’s for 6 months), cold hands and feet


Plan of action for Claire

Given her age – we agreed she would stop trying to conceive for 4 - 6 months. I explained to her, given her very low adrenal output, this could affect not only her own long term health, but could put her at increased risk of miscarriage.

Got her on the best diet possible – it was quite a shift for her to want to come off alkalising diet and include more protein

Worked a lot on how she managed stress – acupuncture; gentle exercise; Often seemed stressed and wired Quite resistant to change The programme itself was stressing her – so worried about what to eat at

Christmas (told her to pick 2 days – have whatever she wants!)


Plan of action for Claire

Diet: put her on a blood sugar balancing diet, increasing her protein intake; reducing sugar;

Gave her as much information as I could, with practical suggestions – links to healthier cereal bars, quick meals, occasional ready meal; kept her on her Ready Brek for breakfast, just added some almonds, seeds and cinnamon instead of sugar;

Supplements: Already on Solgar prenatal nutrients, Natures Aid EFA, Vitamin C 1000mg;

Agreed she would take 4 months without TTC Support for healthy fats – so BMI didn’t drop (as reducing sugar)


Plan for Claire – not TTC

We discussed her lifestyle and how to “let her hair down” a bit… enjoy life;

Took her off prenatal supplement; Started with Nutri Adrenal Extra, 1, increasing to 2 per day;

Then after 1 month, I decided to put her on good quality multi, plus separate adrenal glandular, thyroid glandular, and agnus castus tincture;

It was very important that she agreed to use contraception and not try to conceive

Also tried her on some Nutri Compose – support relaxation response


Follow up with Claire…

She went back to her GP with her test results. He rechecked her cortisol – blood test came back normal (627, normal range 140 – 700).

Claire called me in a panic – there’s nothing wrong with my adrenals I wrote her a detailed letter explaining difference between the tests –

ASI is a functional test, which measures how hormones are performing at cellular level; not how much is carried in the blood, bound to carrier proteins;


Follow up and conclusions:

Claire had 4 months without TTC – feeling very well; more able to cope with stress

Very keen to start trying to conceive again I would have liked to have given her adrenals a bit longer We put her back onto prenatal nutrients, omega 3 fats, and to finish

the packet of adrenal glandular. I didn’t see Claire again – but she had a baby in 2012! Popped into

clinic to book in for some baby classes


Other important functional tests…

Vitamin D testing – standard for my fertility clients. Very simple, £30 each.

Hair Mineral Analysis test – a really useful snapshot and overview Good for someone who is on a budget Have a look at how well they are digesting and processing nutrients Mineral ratio, toxic metals…


Case Study: Hannah. Secondary Fertility Problems

Hannah, age 29. One child – nearly 3. Periods became heavy and irregular after 1st child, put on pill 6 months Secondary Fertility problems: trying to conceive over 2 years Not ovulating every month; about to be given a course of Clomid (blocks oestrogen

receptors in hypothalamus, to raise FSH and LH, stimulate ovulation) Cycles around 34 days; Low BP; can be anxious, worried about not conceiving; Diet was okay – but too much sugar, from juice, hot chocolate, treats, dark choc,

Nutella with breakfast; Had all usual fertility investigations; husband’s semen analysis fine GP blood test results revealed ferritin (iron stores) at 28 (ref 23 – 300)


Hannah’s HMA

High copper – I’ve seen much higher. Cu natural contraceptive (immobilises

sperm). Can be sign of oestrogen dominance, poor adrenal function, poor liver clearance

Hannah being offered ongoing course of clomid – didn’t want to refuse, so didn’t want to stop trying

I felt not right time to detoxify the copper – so while on clomid, support TTC. If no conception, then try to remove copper

High calcium to magnesium ratio – suggests lack of B6, Mg, HCl

Mineral levels low across the board


Husband’s HMA result

Low in many minerals High arsenic – could affect sperm

health Arsenic exposure linked to lower

sperm concentration in men (Xu et al. 2012 Environmental exposure to arsenic may reduce human semen quality: associations derived from a Chinese cross-sectional study. Environmental Health: 1476-069X-11-46)


Plan of action for Hannah & Husband

Both came to appointment; husband “you’re not going to convince me on brown bread!” But she appreciated him hearing about healthy eating, gave her support

Both took on dietary recommendations; focused on iron rich foods for Hannah; blood sugar balancing diet;

For him: cleaned up his diet; good quality multi, extra B6, magnesium (for Ca:Mg ratio), zinc, manganese, vitamin C, selenium and Vitamin E (removal of arsenic);

Used lots of greens – home-made pesto – chelation of toxic metals, especially coriander;

For Hannah: good quality pregnancy multi, organic green barley grass, extra zinc, manganese and Vitamin C to gently increase nutrient levels;


After 1st Appointment:

Hannah did very well with her own diet and getting her husband to eat better – seeds on porridge, less caffeine, wholemeal bread!

Immediately she noticed she was less irritable, less heavy periods, and her skin also felt better;

Fertility clinic increased dose of clomid and extended length of prescription;


Follow up with Hannah:

At second appointment, we decided to increase B6, magnesium and chromium – and if fell pregnant, discussed about reducing these;

Hannah expressed concern about the excess copper and wanted to do all she could to help support its removal

Hannah was also having support from homeopath and acupuncture – really useful as continuing to try to conceive


3rd Appointment Hannah:

By 3rd appt – cycles more like 28 days (were 35), less heavy periods; Found didn’t fancy sweet things any more; By January – found out 7 weeks pregnant; gradually took out extra B

vits and extra B6/Mg and kept on quality MVM for pregnancy; continued green barley grass capsules

Felt a bit dizzy during pregnancy – BP fine; focused on iron rich foods (including some black pudding!)

Successful pregnancy… now have little boy.


I’m pregnant… now what?

Very often clients looking for reassurances during pregnancy As nutritional therapists/nutritionists, we can advise on foods to support

pregnancy, as well as during birthing and breast feeding I often see my clients once per trimester, unless there are specific issues

that need attention Common situations that you may encounter during pregnancy:

hyperemesis gravidarum (severe morning sickness) Gestational diabetes Thyroid issues Anaemia


hyperemesis gravidarum (severe morning sickness)

For some women sickness can be so bad they cannot eat anything Usually subsides after first 20 weeks, can be worse weeks 9 to 13 We’re not sure why some women get it and not others – could be due to

rapidly rising levels of human chorionic gonadotropin (HCG). HCG is released by the placenta.

Excess cortisol and B6 and magnesium deficiencies also thought to play a part?

Eating a balanced diet can be challenging… A woman knows what makes her feel sick – find out and work with that Eg if she wants dry foods, try to get some goodness within that – oat cakes, Nairns

ginger biscuits, wholemeal toast, wholemeal water biscuits


hyperemesis gravidarum (severe morning sickness)

Blood sugar balance may help with morning sickness – with hyperemesis gravidarum this can be more challenging – but do what you can to keep blood sugar balanced.

Best strategy is eating little and often. Ginger – ginger tea, crystallised ginger, ginger biscuits (Nairns) – anti-emetic Keep hydrated – sipping fluids little and often Avoid the smell of food and cooking Suggest acupuncture – can be very effective for morning sickness B6: some research to suggest those with severe nausea of pregnancy have

lower blood levels of B6. Is it safe to give extra B6? In what form?


Pregnancy Anaemia

Most women are checked around 16 weeks for anaemia Is it a result of pregnancy, or were they already anaemic? Often GP will prescribe iron tablets. Give alongside Vitamin C to support

absorption/bowel movement. Suggest iron rich foods: lots of greens, parsley, red meat, fish, chicken

and turkey (especially leg meat), dark cocoa powder, nuts, seeds, dark chocolate, black strap molasses, beans, pulses; if they are drinking, occasional Guinness/stout;

Organic green barley grass or similar; Support mineral breakdown – cider apple vinegar/lemon juice for dressings


Dietary and Supplementary Advice During Pregnancy

Every woman will be given sheets on dietary advice during pregnancy You can really add to this with bespoke advice - bring it to life with practical guidelines

relevant to them “You can affect the health of your grandchildren right now!” “Now’s the time to learn to cook, so you can teach your children!”

Focus on essential fats and oily fish (tuna keep to once per fortnight)/fish oil supplements Blood sugar support Avoid temptation to eat just sugary foods when you’re tired Add goodness to each and every meal Listen to your body – you might crave carbs more than you ever have!


Supplement advice during pregnancy

Get the best quality multi vitamin and mineral for pregnancy Add in some fish oil/omega 3 essential fats – for brain

development, to prevent your own “baby brain” Do they need some extra super foods? Greens product, dark

cocoa powder, baobab powder? Use magnesium salts to support sleep/reduce cramping – nice as foot

soak Probiotics – to help reduce baby’s risk of allergy, especially in 3rd

trimester Support gut movement… Lepicol, psyllium, probiotics, soaked

flaxseed


What’s going in the hospital bag?

You can give very practical advice at this time… Think about meal planning after baby arrives – if anyone visits, they must bring

a meal! Stock up freezer with loads of healthy meals. Hospital bag: it’s tea, biscuits and sandwiches in hospital. Suggest taking

things such as: Nakd bars, healthy snack bars, oatcakes, honey, dark chocolate, organic squash, herbal

teas… and a straw! First few weeks of breastfeeding… put your client in touch with local

breastfeeding support groups; talk to her about keeping blood sugar balanced, and avoiding temptation to fill up on sugary things to keep going;

Breast milk only as healthy as Mum… need lots of DHA, good bacteria, iron etc…


Post natal burn out… why?

Radical transformation to a Mum’s life…. Often takes time to adjust Adrenals were struggling before pregnancy… then lack of sleep,

depletion of nutrient reserves… especially after second pregnancy Pregnancy is the trigger event… lots of antecedents

Commonly describe continual coughs and colds; non-existent sex drive; losing confidence; feel like don’t know who they are any more; no time to eat well

Baby and children always come first… Mum forgets her own needs Feel guilty when relaxing… house becomes their work, when baby asleep or

children at school – never resting. Or working. Taking care of children, all responsibilities, plus work/own business….


Karol, age 31

One child, age 2. Son never slept well, couldn’t put him down; Severe morning sickness first 12 weeks pregnancy

Lot of previous stress – traumatic event in 20s, food poisoning when travelling “Feels like immune system not functioning – got a cold all the time” Constant fatigue – diagnosed with CFS. “Feel rubbish all day, every day.” Low blood pressure Headaches, foggy head, brain fog; can’t recover after exercise Stomach cramps; feel sick; constipation; history H.Pylori History of low iron, periods very heavy, fibroids;


ADRENALS!


Karol, age 31

So keen to do some testing – “want to know this isn’t in my head”


Karol: Post-natal Case Study Continue

Existing diet: Weetabix, banana and coffee breakfast; sandwich and coffee for lunch, sometimes soup; toast and butter, crisps; evening meal usually good home-cooked meals; chocolate snacks; sugary drinks;

Also doing a lot of intense exercise Started with blood sugar balancing diet, more protein, less sugar; Gave her very practical suggestions which fit around her family:

Some days – overnight oats, flaxseed, fruit; on days less time, rye toast and peanut butter, or adding some nuts to her weetabix


Karol: Post-natal Case Study Continue

Reduced exercise – should be enjoyment, not another chore Added in gentle cardio, more relaxation – yoga, Pilates, massage; We talked about ways to support mindfulness… being more playful

with her son; forgetting the washing and getting outside; rather than trying to plant garden herself (and getting stressed about it), getting her son involved;

Initially gave her Mega Mag Energen Plus (Nutri) – nice B vit, magnesium formula, with L-Carnitine, iodine


Karol: Post-Natal Case Study

Following 1st appointment – already feeling some improvement – better quality of sleep, less tired; not getting afternoon crash;

Still getting headaches, groggy on waking like hangover Sometimes banging heart in the morning; Changed her onto Adrenal support formula (Super Adrenal Stress Formula) Received email: feeling so much better; getting more quality sleep, for

first time in 10 years woke up without feeling tired; Later joined my 30 day Sugar detox workshop – really enjoyed new recipes


Questions?

Preconception to post-natal health: case studies and clinical pearls, with Catherine Jeans

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Transcript of Preconception to post-natal health: case studies and clinical pearls, with Catherine Jeans